The Role Of Hysteroscopy In The Diagnosis Of Tamoxifen-associated Endometrial Pathology

Objective:Toexplorethesonographicfeatures,theevolutiveendometrial hysteroscopic patterns and histopathological findings in patients with breast cancer undergoing long-term tamoxifen treatment.To analyze the value of hysteroscopy in the diagnosis of tamoxifen-associated endometrial pathology,to explore the gynaecologocal monitoring method during tamoxifen therapy.Methods:44 patients treated with long-term TAM after breast cancer visited the General Hospital of Tianjin Medical University because of abnormal uterine bleeding or endometrial thickening et al from February 2014 to March 2018 were analyzed retrospectively.All 44 patients were examined by transvaginal ultrasonography,hysteroscopy and endometrial biopsy.To analyze the relationship between tamoxifen-exposed time and endometrial thickness and hysteroscopic morphological changes.To Compare the sensitivity,specificity,positive predictive value,and negative predictive value of TVS and hysteroscopy in the diagnosis of endometrial pathology.result:1.There were 44 patients in our study,mean age 56.05±9.33 years(range 41~79),including premenopausal women 14 cases,mean age 47.86±4.78 years(range 41~55),postmenopausal women 30 cases,mean age 59.87±8.44 years(range 47~79),The reasons for premenopausal women coming to the department of gynecology were abnormal uterine bleeding(11/14,78.57%),trangvaginal ultrasonograph suspected endometrial polyps(2/14,14.29%),hysteromyoma(1/14,7.14%).The reasons for postmenopausal women coming to the department of gynecology were abnormal uterine bleeding(21/30,70%),trangvaginal ultrasonograph suspected endometrial polyps or endometrial thickening(6/30,22%),hysteromyoma(2/30,6.67%),abnormal vaginal discharge(1/30,3.33%).2.The average age of 44 patients treated with TAM was 4.66±4.02 years.The average endometrial thickness measuring by TVS was 14.92±13.52mm.There was a weak correlation between endometrial thickness and time exposed to TAM(Useing linear correlation was used,and Pearson product moment coefficient was 0.30,P=0.04<0.05,with significant differences).3.Tamoxifen produces five different endometrial patterns in hysteroscopy:normal endometriumpattern,hypervascularizedpattern,cysticpattern,Endometrial polyps,suspicious of malignancy.The normal endometrium morphology appeared in14 patients(31.81%),The hypervascularized pattern appeared in 4 patients(9.09%),The cystic pattern appeared in 2 patients(4.55%),Endometrial polyps appeared in 18patients(40.91%)and 6 had an endometrial pattern suspicious of malignancy(13.64%).There was a positive correlation between endometrial patterns and time exposed to TAM(using rank correlation,Spearman rank correlation coefficient was0.43,P=0.003<0.05,with significant difference).4.The distribution of endometrial pathology in 44 patients treated with TAM was different in premenopausal and postmenopausal women(?~2=12.61,P=0.006<0.05).Endometrial cancer mainly occurred in postmenopausal women.Premenopausal women were mainly performed benign endometrial diseases;There was a correlation between pathological findings and time(using rank correlation:Spearman rank correlation coefficient was 0.450,P=0.002<0.05,with significant differences).5.The sensitivity of hysteroscopy in diagnosis tamoxifen-associated endometrial diseases was 100%,specificity was 70%,positive predictive value was 80%,negative predictive value was 100%;of TVS,the result was 95.83%,55%,71.88%,and91.67%respectively.The sensitivity of hysteroscopy in diagnosis tamoxifen-associated endometrial cancer was 100%,specificity was 95%,positive predictive value was66.7%,negative predictive value was 100%;of TVS,the result was 100%,30%,12.5%,and 100%respectively.The specificity and positive predictive value of hysteroscopy in the diagnosis of endometrial cancer were better than those of TVS(P<0.05).Conclusion:1.There was a weak correlation between endometrial thickness and time exposed to TAM.2.Tamoxifen produces five different endometrial patterns in hysteroscopy:normal endometrium pattern,hypervascularized pattern,cystic pattern,endometrial polyps and suspicious of malignancy.There was a positive correlation between endometrial pattern and time exposed to TAM,the endometrium gradually played an trend:normal endometrium pattern,hypervascularized pattern,cystic pattern,endometrial polyps and suspicious of malignancy.3.The woman who postmenopausal and longer exposed to TAM was more likely to develop endometrial cancer.4.The specificity and positive predictive value of hysteroscopy in the diagnosis of endometrial cancer were better than those of TVS.